Whole of Society; Whole of Government; The case of NCDs By George Alleyne Kingston, Jamaica 29 May, 2012

Responding to the challenge: a whole- of-government and a whole-of-society effort : Recognize that the rising prevalence, morbidity and mortality of non-communicable diseases worldwide can be largely prevented and controlled through collective and multisectoral action by all Member States and other relevant stakeholders at the local, national, regional and global levels,…….. Para 33: Recognize that the rising prevalence, morbidity and mortality of non-communicable diseases worldwide can be largely prevented and controlled through collective and multisectoral action by all Member States and other relevant stakeholders at the local, national, regional and global levels,……..

Develop options for multisectoral action for effective partnerships action for effective partnerships Political Declaration Para 64

Times “multisectorial “ mentioned in UN “health” documents Political Declaration NCDs 2011………..15 Political commitment HIV/AIDS 2001……2 Agenda 21. Chapter ……………0 Multisectoriality ? Significance and policy implications of new emphasis

Multilateral Actions Efforts Responses Public policies Nat.Policies Interventions Approaches Engagenment

Whole of society Whole of society I equate with the bodies of the STATE I equate with the bodies of the STATE government, private sector (business), government, private sector (business), civil society civil society Whole of government Whole of government I equate with all the administrative I equate with all the administrative divisions and institutions of divisions and institutions of government government

Govern ment Private sector Civil Society Agr. Fin. Hlth Trade Etc PM Divisions STATE GOVERNMENT

Government —Well defined Business --Polymorphic-Businesses touch every risk factor for NCDs risk factor for NCDs Civil society- -Polymorphic NGOs-Thematic and non-thematic NGOs-Thematic and non-thematic Faith-based organizations Faith-based organizations Professional organizations Professional organizations Media Media Organized labor Organized labor Etc Etc

Sectoral responsibilities Government Government Produce public goods Produce public goods Public order Public order Business Business Produce goods and services efficiently Produce goods and services efficiently Make a profit Make a profit Civil society Civil society Guardian of community values Guardian of community values Serve as a broker Serve as a broker

Tools available Government Civil society Business Legislation Regulation Taxation Agitate Inform Philanthropy Product power Shared value

Sectoral continuum A BC A BC?D Interests Sectors

Multisectoral cooperation Health A B C Services Individual and population health status Government Divisions

Intersectoral cooperation Government Business Civil Society Health

Strategies to address NCDs Population based interventions; Primary prevention Clinical interventions Secondary prevention Healthy NCD Society/environment Individual

Managing the interaction Whole of government ( Multisectoral) Primacy of Health Ministry -Data on NCDs and Risk factors Imprimatur of Head of Government Health Impact Assessment

Health Impact Assessment (HIA) is a means of assessing the health impacts of policies, plans and projects in diverse economic (sic) sectors using quantitative, qualitative and participatory techniques. ( WHO)

The major steps in conducting an HIA include Screening (identify projects or policies for which an HIA would be useful), Scoping (identify which health effects to consider), Assessing risks and benefits (identify which people may be affected and how they may be affected), Developing recommendations (suggest changes to proposals to promote positive or mitigate adverse health effects), Reporting (present the results to decision-makers), and Evaluating (determine the effect of the HIA on the decision). (CDC)

An outline scheme for health impact assessment, showing the place of “evidence” in the process. Mindell J et al. J Epidemiol Community Health 2004;58: © 2004 by BMJ Publishing Group Ltd Health Impact Assessment

Intersectoral involvement in addressing NCD risk factors Risk factorGovernmentPrivate sector Civil society Tobacco Physical activity ++++ Harmful use of alcohol ++++?++ Unhealthy diet +++++?

Conclusions Whole of society and whole of government shaped as intersectoral and multisectoral approaches The differences between the two set out The multisectoral theoretically easier, given our forms of government and tools available The intersectoral more difficult, given the polymorphic nature and interests of the private sector and civil society